發(fā)布時間：2018-03-31 09:47

  本文選題：磁共振成像　切入點：可逆性后部腦病綜合征　出處：《河北醫(yī)科大學》2014年碩士論文

【摘要】：可逆性后部腦病綜合征(Reversible Posterior Encephalopathy Syndrome. RPES)癥狀體征進展迅猛,雙側(cè)大腦半球后部白質(zhì)發(fā)生可逆性病變?yōu)槠涞湫陀跋癖憩F(xiàn),其性質(zhì)為血管源性水腫。大多數(shù)患者血壓明顯高,或者患有一些基礎疾病,MRI為診斷RPES的重要檢查方法,DWI及ADC序列能鑒別腦部發(fā)生缺血性病變的細胞毒性水腫與RPES的血管源性水腫。若診斷和治療及時,癥狀及影像學異�？赏耆謴驼�；如果延誤診治,將會導致持久的神經(jīng)功能障礙,甚至死亡。目的：旨在探討可逆性后部腦病綜合征(RPES)磁共振表現(xiàn)特點及ADC值的變化從而來評價其臨床應用價值,從而提高臨床醫(yī)生認識RPES,并做到早期診斷、正確識別及早期治療方法：收錄2011年1月-2014年1月期間30例MRI檢查確診患者,回顧性分析其MRI特點。測得30例RPES患者病變區(qū)域的ADC值,歸為病變組,同時與之相匹配的是年齡、性別均相同的健康志愿者,測得其相對應部位的ADC值,納入對照組,將這兩組進行比較。結(jié)果：1本組30例患者中男性9例,女性21例,女性比例偏高。最常見病因為高血壓病和妊娠高血壓子癇或子癇前期,繼發(fā)于妊娠高血壓17例(60.3%),高血壓病7例(23.3%)；其他病因為系統(tǒng)性紅斑狼瘡1例,過敏性紫癜1例,腎病綜合征3例,另發(fā)現(xiàn)干燥綜合征1例。2發(fā)病急,血壓常在急性期出現(xiàn)顯著增高,少數(shù)輕微升高或正常,其臨床表現(xiàn)為以頭痛、癲癇,意識障礙,視力障礙四聯(lián)征最常見。3影像學表現(xiàn)：30例患者均行常規(guī)MRI掃描、DWI、ADC、MRA及MRV掃描,顯示頂葉28例(93.3%)均受累,同時伴枕葉受累26例(86.7%),后循環(huán)其他部位也可受累,如小腦6例(20%)、中腦及橋腦4例(13.3%),胼胝體1例(3.3%)。除后循環(huán)外,前循環(huán)也可受累,如額顳葉10例(33.3%)、基底節(jié)區(qū)5例(16.7%)、丘腦4例(13.3%)及腦室旁白質(zhì)3例(10%),絕大多數(shù)病變在枕葉,上述部位亦可累及。RPES的磁共振影像學特征主要表現(xiàn)為大腦后部皮層及皮層下對稱性病灶,T1WI呈等或略低信號,T2WI及FLAIR序列上呈高信號,FLAIR高信號更為明顯；DWI呈等信號或稍低信號,ADC圖呈高信號；病變組ADC值為0.712-1.256×10-3mm2/s,平均值為1.116×10-3mm2/s,而對照組ADC值則為0.623-0.83610-3mm2/s,平均為0.726×10-3mm2/s,對照組ADC值低于病變組,P值為0.043,差異有統(tǒng)計學意義(P0.05)。本組30例經(jīng)治療(2周)后復查MRI,8例病變較前明顯減少,22例完全消失。4本病明確診斷需通過其臨床特有表現(xiàn)和MRI獨特表現(xiàn),加上癥狀、體征及影像學在經(jīng)過2周治療后恢復正常或明顯好轉(zhuǎn)。應緊密觀察患者的發(fā)病史、既往史、臨床癥狀、腰穿以及實驗室檢查,有時需要結(jié)合治療和轉(zhuǎn)歸等。結(jié)論：RPES主要臨床癥狀為頭痛、頭暈、癲癇發(fā)作、意識障礙、視覺障礙。其常見病因為高血壓腦病及妊娠高血壓征子癇或子癇前期。磁共振影像學特征主要表現(xiàn)為大腦后部皮層及皮層下出現(xiàn)對稱性T1低信號,T2高信號,長FLAIR信號更為顯著；等或略低DWI信號,ADC圖呈顯示高信號,測量病變組及對照組ADC值變化,病變組明顯比對照組高。經(jīng)過治療后臨床癥狀和磁共振影像學特征可以完全恢復正常,說明一般預后良好,若診治不及時,則可以造成不可逆性神經(jīng)功能損害。
[Abstract]:Posterior reversible encephalopathy syndrome (Reversible Posterior Encephalopathy Syndrome. RPES) symptoms and signs of rapid progress, bilateral posterior cerebral hemisphere white matter occurrence of reversible disease is the typical manifestations of the nature of vasogenic edema. Most patients with high blood pressure significantly, or suffering from some diseases, MRI is an important method for diagnosis of RPES, DWI and the ADC sequence can vasogenic edema and cytotoxic edema in ischemic brain RPES in the differential diagnosis of lesions. If timely diagnosis and treatment can be completely restored to normal, abnormal symptoms and imaging studies; if the delay in treatment, will lead to permanent neurological dysfunction, and even death. Objective: To study the posterior reversible encephalopathy syndrome (RPES) the change characteristics and the value of ADC MRI to evaluate its clinical application value, so as to improve clinician awareness of RPES, and achieve the early diagnosis , correct identification and early treatment methods: during the period January 2011 -2014 year in January included 30 cases of MRI diagnosed patients were retrospectively analyzed. The characteristics of MRI measured in 30 patients with RPES, the ADC values of lesions, classified as lesion group, and matched the age, gender were the same in healthy volunteers, measured the the corresponding part of the value of ADC in the control group, the two groups were compared. Results: the 1 group of 30 patients, male 9 cases, female 21 cases, the high proportion of women. The most common disease because of hypertension and gestational hypertension or preeclampsia eclampsia, 17 cases of hypertension secondary to pregnancy (60.3%), 7 cases of hypertension (23.3%); 1 cases of other diseases because of systemic lupus erythematosus, 1 cases of allergic purpura, 3 cases of nephrotic syndrome, the other found Sjogren syndrome in 1 cases of.2 acute onset, blood pressure often appear in the acute period increased significantly, a slightly elevated or normal, the clinical manifestation is to head 鐥，

本文編號：1690197